MULTIPLE SCLEROSIS - OXYMED HYPERBARIC OXYGEN THERAPY TIER 2
Multiple sclerosis survivors swear by hyperbaric oxygen – but does it work?
There is no cure for multiple sclerosis (MS) yet. As a complex neurodegenerative disease of the brain, it is incredibly difficult to treat. Despite the development of new and sophisticated therapies to control the inflammation and physical symptoms of the disease, these treatments don’t work for everyone. This is because MS comes in many guises and one treatment does not fit all. Perhaps for this reason people with MS are turning to alternative means of controlling their condition.
Many of the 100,000 people with MS in the UK have taken charge of managing their treatment. With the assistance of 60 or more independent charitable MS therapy centres, people with the disease regularly enter a chamber and breathe oxygen under moderate pressure (hyperbaric oxygen). Some people have done so for more than 20 years.
The air we breathe contains 21% oxygen, but 100% oxygen is considered a drug and is prescribed in hospitals to aid people’s recovery. In the case of MS, people self-prescribe the hyperbaric oxygen, which is delivered to them by trained operators. But does breathing pure oxygen under pressure on a weekly basis do them any good?
The idea to use oxygen as a treatment for MS began over 45 years ago. In 1970, two Romanian doctors, Boschetty and Cernoch, treated patients with brain injuries with pressurised oxygen to help more oxygen enter their tissues – oxygen helps protect nerve cells from damage and maintains the integrity of the blood-brain barrier. In a study of MS patients, they found that symptoms in 15 out of 26 volunteers improved. This led to further interest in the use of hyperbaric oxygen to treat MS specifically.
Since Boschetty and Cernoch’s discovery, around 14 clinical trials have been conducted. The trials have been on relatively small numbers of people and have reported conflicting results, ranging from great improvements to none at all. This has led to a dilemma: should clinicians endorse the use of hyperbaric oxygen for MS or not?
Not officially sanctioned
The clinical regulatory bodies in the US and the UK, the FDA and NICE respectively, do not feel the clinical trial evidence is strong enough to endorse the procedure, yet thousands of people in the UK and elsewhere continue to treat themselves with hyperbaric oxygen.
Between 1982 and 2011, over 20,000 people with MS in the UK used hyperbaric oxygen over 2.5million times.
Multiple sclerosis is a chronic inflammatory disease of the brain. It is usually diagnosed between the ages of 20 and 40. Lesions in the brain develop as a result of inflammatory autoimmune cells crossing the blood-brain barrier and destroying the protective protein coat (myelin) that surrounds the axon of some nerve cells. Over time MS develops into a neurodegenerative disease, leading to problems with vision, bladder control and mobility.
The brain’s ability to repair some of this damage helps people with MS to feel better for a while before relapsing once more. Eventually the disease becomes chronic and the ability to repair the damage and undergo remission declines. Most conventional treatments focus on the early phases of the disease. Unfortunately, there are few treatments for the later stages of MS.
Perhaps the inability of prescribed drugs that work for all people with MS, or indeed work for some but produce unpleasant side-effects, has driven people to seek other treatments. Despite the scepticism of some doctors, many people with MS claim that hyperbaric oxygen therapy has benefits.
The benefits include improvements in mobility, bladder control, pain relief and gait. However, since the treatment is transient, regular exposure to pressurised oxygen is required to sustain any benefit.
The increase in oxygen to the brain may lead to a number of effects such as speeding repair to damaged tissue, or inhibiting the ability of immune cells to cross the blood-brain barrier and cause damage. These possibilities are being investigated.
Poorly designed trials
So why are many clinicians sceptical of hyperbaric oxygen? The main reason is various MS disability-status scores are used to judge improvement. In the former clinical trials, hyperbaric oxygen was not used over a sustained periods of time (only a few weeks) and often people with irreversible damage were used, so no or very little improvement in scores was seen.
So are poorly controlled clinical trials to blame for the conflict of opinion? Probably, yes.
Until we understand more at the molecular level about how oxygen under pressure can make sustained changes to various biological processes in the brain, people with MS will continue to use the treatment and the majority of the medical community will remain unconvinced of its merits.
Oxygen therapy: Fresh air relief for multiple sclerosis patients.
CAN regularly inhaling pure O2 help ease the symptoms of multiple sclerosis?
Published: 04:57, Tue, January 7, 2014 Visit msntc.org.uk
UK 64 MS HBO Treatment Facilities
Photos of Oxfordshire Multiple Sclerosis Therapy Centre
Every week Brendan Hilton steps into a high-pressure chamber, pulls a mask over his face and breathes in a high dose of oxygen. The 32-year-old, who suffers from multiple sclerosis, has found that the treatment eases symptoms of the incurable disease.
In the UK and Ireland about 5,000 patients regularly have oxygen therapy lasting about an hour in chambers holding up to 12 people.
It uses the same technology as in the pressurised cabins of passenger jets and some research suggests that delivering high doses of pure oxygen can reduce inflammation which is a key feature of MS.
The treatment is offered at more than 60 centres throughout the UK, each run as an individual charity.
"I feel energised and sleep better after having oxygen," says Brendan, a former car mechanic who was diagnosed with the disease seven years ago. He initially noticed that he was suffering from double vision but it took six years for the cause to be established.
"I was playing pool on holiday and couldn't see the balls properly," he explains. "I was also suffering from headaches. It happened again at work about a year later." Tests revealed a swelling on the nerve ending behind the eye. It was treated purely as a vision problem but is one of the first signs of MS.
Brendan adds: "It would flare up occasionally, then my mum pointed out that I was crossing my feet when I was walking. I realised it was due to a weakness in my right hip."
Finally following an MRI scan Brendan was called in urgently by a neurologist and told he had MS, a condition that affects the central nervous system including the brain, spinal cord and optic nerves.
"My first reaction was disbelief and I thought they had mixed up my medical records," says Brendan. "I didn't know much about MS and assumed I would end up in a wheelchair but as I learned more, I was determined to get on with life."
Brendan improved his diet, began exercising more and now rarely drinks alcohol. He also heard about the network of more than 60 MS Therapy Centres in the UK. They offer a range of treatments including oxygen therapy.
"I am open-minded and oxygen therapy made a lot of sense," says Brendan. "If you have an accident, oxygen is the first thing they give you. It's not a cure but I've no doubt that it helps."
Some studies suggest the treatment helps ease symptoms such as incontinence, pain and fatigue. However oxygen therapy divides medical opinion and is not available on the NHS for MS.
POSSIBLE BENEFIT: Oxygen therapy can ease symptoms, but only in some patients.
Oxygen treatment is not a cure and people need to be realistic. If you are in a wheelchair it's not going to get you walking again. The use of oxygen to treat MS was introduced in the UK in Dundee in 1982. For reasons that are not clear but may be linked to lifestyle and climate, Scotland has one of the highest rates of MS in the world.
Petra Kliempt, co-ordinator for MS Therapy Centres, says: "Oxygen is the body's antibiotic. It helps against infection and the inflammation caused by MS."
The chambers used at the centres deliver air which is pressurised at twice the normal atmospheric level. This allows high doses of oxygen to reach and repair damaged tissue.
Some studies suggest that over a long period oxygen can slow the effects of MS. It is also claimed that the therapy can stimulate the production of stem cells which may allow some of the damage caused by MS to be repaired. "Treatment tends to be more successful if begun soon after diagnosis.
Hyperbaric oxygen therapy was first used in 1887 to treat pneumonia and since the 1930s for deep-sea divers suffering from decompression sickness. It has also been used to help treat a range of illnesses and conditions including stroke, diabetes and brain injury. Other studies have cast doubt on the treatment but Petra adds: "There are clear benefits and no side effects. I have not encountered any MS patients who report no improvement and for some it is dramatic.
"People have reported that the effects are like having a fog cleared from around their brain.
"However oxygen treatment is not a cure and people need to be realistic. If you are in a wheelchair it's not going to get you walking again. We do believe this treatment should be made available on the NHS but there is a lack of awareness among GPs while others are sceptical about the importance of using oxygen in treatment."
Ed Holloway of the MS Society says: "Some people with MS who receive hyperbaric oxygen therapy have found that it helps to improve their symptoms but others haven't found any benefit. "There have been a number of studies looking into its potential benefits but overall they haven't found any clear evidence that it is an effective treatment."
Most patients have an intensive introductory course of 20 hour-long sessions then scale back depending on their symptoms. Anyone having the treatment is asked to make a small donation.
There are about 100,000 MS sufferers in the UK so oxygen therapy is still only being used by a fraction. The condition occurs most commonly in people aged between 20 and 40 and twice as many women as men are affected.
Brendan, who has the relapsing remitting form of MS, has oxygen therapy at a centre near his home in Hereford alongside conventional drug treatment. Although he still struggles with his balance due to leg weakness his condition is now more stable and he is able to enjoy hobbies including fishing. Next year he is due to get married to Helen, a supervisor at the centre.
He says: "If I miss a session I really notice the difference. Even with oxygen treatment I still have times when I can't face the world and just have to take it easy.
"However when you have an incurable condition anything that works for you has to be worth it."
OXYMED provides saturative blocks of Hyperbaric Oxygenation (HBOT) combined with Australian first LOKOMAT (Robotic Gait Training - Adult and Paediatric) to promote neuroplasticity - the ability of neural pathways to foster and develop new connections and ‘learn’ new functions.
Other supportive modalities include Cryotherapy, MonoRail Walking, Median Nerve Stimulation, Whole Body Vibration and immune stimulating supplements including Vitamin D.
OXYMED combination protocols ‘awakens’ dormant neural pathways and provides accurate neurological repetition enhancing and re-training connections and pathways in the brain and spinal cord. Patients have the ability to ‘salvage back’ what has been damaged - the capacity to wake-up dormant pathways, rewire, retrain and reconnect function improving brain and spinal cord function.
BMC Neurology - December 2016
We retrospectively reviewed 25 secondary progressive (SP)-MS patients from the hospital database. Neurological disability evaluated by Expanded Disability Status Scale Score (EDSS). Brain perfusion was performed by (99 m) Tc-labeled bicisate (ECD) brain SPECT and the data were compared using statistical parametric mapping (SPM).
In total, 16 patients underwent HBOT. Before HBOT and at the end of 20 sessions of oxygen treatment, 99mTc-ECD brain perfusion single photon emission computed tomography (SPECT) was performed again then the results were evaluated and compared. Brain perfusion was performed by (99 m) Tc-labeled bicisate (ECD) brain SPECT and the data were compared using statistical parametric mapping (SPM).
A total of 25 SP-MS patients, 14 females (56 %) and 11 males (44 %) with a mean age of 38.92 ± 11.28 years included in the study. The mean disease duration was 8.70 ± 5.30 years. Of the 25 patients, 2 (8 %) had a normal SPECT and 23 (92 %) had abnormal brain perfusion SPECT studies. The study showed a significant association between severity of perfusion impairment with disease duration and also with EDSS (P <0.05). There was a significant improvement in pre- and post-treatment perfusion scans (P <0.05), but this did not demonstrate a significant improvement in the clinical subjective and objective evaluation of patients (P >0.05).
This study depicted decreased cerebral perfusion in SP-MS patients with a moderate to severe disability score and its association with clinical parameters. Because of its accessibility, rather low price, practical ease, and being objective quantitative information, brain perfusion SPECT can be complementing to other diagnostic modalities such as MRI and clinical examinations in disease surveillance and monitoring. The literature on this important issue is extremely scarce, and follow up studies are required to assess these preliminary results.
Long-term hyperbaric oxygenation retards progression in multiple sclerosis patients - UK Experience
D J D Perrins1 , P B James2: 1MS National Therapy Centres, Bedford MK41 9RX 2Wolfson Hyperbaric Medicine Unit, University of Dundee. DD2 4BF Received 18 April 2005; accepted 23 August 2005
Objective: To evaluate the effect of prolonged courses of hyperbaric oxygen treatment (HBO2T) on the progressive deterioration of multiple sclerosis (MS) patients.
Design: Prospective study of the disability of 703 MS patients first treated five or more years previously.
Setting: The MS National Therapy Centres in the UK and Ireland.
Results: Of the 117 patients who had attended regularly and without interruption for 5 to 15 years, the Kurtzke value (KDS) had not increased by more than 1 point. One hundred and four of 1384 patients (11%) first treated 17 or more years previously were still attending for regular treatment.
About 300 treatments in 10+ years (about once a fortnight) were required to appreciably retard the progression of disability of Relapsing/Remitting patients, while more than 500 treatments (say, once a week) were more effective.
Conclusions: The response to treatment is better in patients with less advanced disease and is related to the frequency and continuity of treatment. Treatment should therefore be started as soon as the condition is diagnosed and before irreversible lesions have become established.
J Neurol Sci. 2015 Mar 15;350(1-2):18-23. doi: 10.1016/j.jns.2015.01.030. Epub 2015 Jan 28.
Interleukin-10 but not transforming growth factor-β1 gene expression is up-regulated by vitamin D treatment in multiple sclerosis patients
1Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran.
2Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran. Electronic address: email@example.com.
3MS Research Center, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran.
Multiple sclerosis (MS) is an inflammatory and autoimmune disease. Variety of different genetics and environmental factors are involved in MS pathology. The epidemiological studies demonstrated that vitamin D has immune and immunomodulating effects on MS disease.
Therefore, this study aims to evaluate the effect of vitamin D treatment on the expression of interleukin-10 (IL-10) and transforming growth factor-β1 (TGF-β1) genes in MS patients.
We found that, the expression level of IL-10 gene in treated patients was up-regulated 3.84 times more than before treatment, but the expression level of TGF-β1 was not affected by vitamin D treatment. Also, a significant relationship was observed between vitamin D level and EDSS in MS patients.
Our results indicated that the increased level of serum vitamin D and IL-10 gene expression may be associated with the reduction of EDSS scores in MS patients.
J Neuroimmunol. 2015 Aug 15;285:125-8. doi: 10.1016/j.jneuroim.2015.05.022. Epub 2015 Jun 12.
Effect of high dose vitamin D intake on interleukin-17 levels in multiple sclerosis: A randomized, double-blind, placebo-controlled clinical trial
1Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: firstname.lastname@example.org.
2Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neuroscience Research Centre, Iran.
3University of Isfahan, Department of Biology, Isfahan, Iran.
4Department of Biostatistics and Epidemiology, Health School, Isfahan University of Medical Sciences, Isfahan, Iran.
Vitamin D has immunomodulatory effects in multiple sclerosis (MS). Vitamin D acts through various mechanisms such as secretion of cytokines. Interleukin-17 (IL-17) is a critical interleukin in inflammatory response in MS.
This study assessed the effect of oral high dose vitamin D intake on IL-17 levels in MS patients in a double blind randomized clinical trial.
94 patients with a diagnosis of relapsing remitting multiple sclerosis (RRMS) were randomized to two groups. One group received 50,000 IU vitamin D3 every five days for 12 weeks. The other group was given placebo. Both groups received interferon-β (IFN-β) treatment. Serum levels of IL-17 were measured at the beginning of the study and after 12weeks.
IL-17 serum levels were 56.75±28.72pg/ml and 30.31±75.85pg/ml in the intervention and placebo group at the beginning of the study, respectively (Median±IQR, p=0.338). After 12weeks, IL-17 levels were 58.93±67.93pg/ml and 46.13±94.70pg/ml in the intervention and placebo group, respectively (Median±IQR, p=0.960). The multiple linear regression analysis indicated that the consumption of vitamin D3 was positively and significantly associated with the logarithm of IL-17 measures (β=1.719; p=0.002 and R2=0.91), adjusted by EDSS scores.
IL-17 levels showed significant change in RRMS patients after receiving high dose vitamin D3 for 12weeks.
PLoS One. 2015 Jun 24;10(6):e0130395. doi: 10.1371/journal.pone.0130395. eCollection 2015.
Vitamin D regulates cytokine patterns secreted by dendritic cells to promote differentiation of IL-22-producing T cells
1Department of Dermatology, University of Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.
One central mechanism, by which vitamin D regulates human immune responses, is the direct modulation of dendritic cells (DCs). However, the effect of vitamin D on several key DC functions, such as the secretion of central inflammatory cytokines, remains controversial. Moreover, whether vitamin D treatment of DCs regulates their ability to promote differentiation of IL-17-/IL-22-producing T cell subsets, such as Th17 and Th22 cell, is not known.
Here, we report that vitamin D treatment during differentiation of monocytes into DCs markedly enhanced their ability to secrete TNF-α, IL-6, IL-1β and IL-23. Cytokines secreted by vitamin D-treated DC were significantly more potent in driving differentiation of IL-22-producing T cells, but not IL-17-producing T cells, as compared to secreted cytokines of not-vitamin D-treated DCs. Finally, we found that the differentiation of IL-22-producing T cells mediated by supernatants of vitamin D-treated DCs was dependent on TNF-α IL-6 and IL-23.
In summary, our study suggests a novel role of vitamin D in regulating DC-mediated immune responses in humans.
Mult Scler. 2013 Jul 25. [Epub ahead of print]
Tumor necrosis factor is elevated in progressive multiple sclerosis and causes excitotoxic neurodegeneration
Clinica Neurologica, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy.
Chronic inflammation leads to gray matter damage in progressive multiple sclerosis (MS), but the mechanism linking inflammation and neurodegeneration is unclear.
The objective of this paper is to investigate the synaptic mechanism of inflammatory neurodegeneration in progressive forms of MS.
Cytokine and neurofilament-light were determined in cerebrospinal fluid (CSF) of MS patients. In vitro electrophysiology and cell swelling experiments were performed to measure the effects of inflammatory cytokines in the CSF of MS patients on synaptic transmission and neuronal integrity.
Tumor necrosis factor-α (TNF) was higher in CSF of progressive MS subjects, and caused excitotoxic neuronal death in vitro. In murine brain slices incubated in the presence of CSF from progressive MS, in fact, we observed increased spontaneous excitatory postsynaptic currents (sEPSCs) and glutamate-mediated neuronal swelling through a mechanism dependent on enhanced TNF signaling. We also suggested a pathogenic role of B cells in TNF CSF increase, exacerbation of glutamatergic transmission and neuronal damage, since CNS depletion of B cells with intrathecal rituximab caused a dramatic reduction of TNF levels, of TNF-induced sEPSC alterations, and of neurofilament CSF concentrations in a patient with progressive MS.
Our results point to TNF as a primary neurotoxic molecule in progressive forms of MS.
Potential role of IL-13 in neuroprotection and cortical excitability regulation in multiple sclerosis
Mult Scler. 2011;17:1301–1312.
Rossi S, Mancino R, Bergami A, Mori F, Castelli M, De Chiara V, Studer V, Mataluni G, Sancesario G, Parisi V, Kusayanagi H, Bernardi G, Nucci C, Bernardini S, Martino G, Furlan R, Centonze D. . doi: 10.1177/1352458511410342. [PubMed] [Cross Ref]
Background: Inflammation triggers secondary neurodegeneration in multiple sclerosis (MS).
Objectives: It is unclear whether classical anti-inflammatory cytokines have the potential to interfere with synaptic transmission and neuronal survival in MS.
Methods: Correlation analyses between cerebrospinal fluid (CSF) contents of anti-inflammatory cytokines and molecular, imaging, clinical, and neurophysiological measures of neuronal alterations were performed.
Results: Our data suggest that interleukin-13 (IL-13) plays a neuroprotective role in MS brains. We found, in fact, that the levels of IL-13 in the CSF of MS patients were correlated with the contents of amyloid-β1-42. Correlations were also found between IL-13 and imaging indexes of axonal and neuronal integrity, such as the retinal nerve fibre layer thickness and the macular volume evaluated by optical coherence tomography. Furthermore, the levels of IL-13 were related to better performance in the low-contrast acuity test and Multiple Sclerosis Functional Composite scoring. Finally, by means of transcranial magnetic stimulation, we have shown that GABAA-mediated cortical inhibition was more pronounced in patients with high IL-13 levels in the CSF, as expected for a neuroprotective, anti-excitotoxic effect.
Conclusions: The present correlation study provides some evidence for the involvement of IL-13 in the modulation of neuronal integrity and synaptic function in patients with MS.
Efficacy of fish oil on serum of TNF α , IL-1 β , and IL-6 oxidative stress markers in multiple sclerosis treated with interferon beta-1b
Oxid Med Cell Longev. 2013;2013:709493. doi: 10.1155/2013/709493. Epub 2013 Jun 18.
Laboratorio de Mitocondria-Estrés Oxidativo & Patología, División de Neurociencias, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Sierra Mojada 800, 44340 Guadalajara, JAL, Mexico.
Multiple sclerosis (MS) is a chronic inflammatory disease, which leads to focal plaques of demyelination and tissue injury in the central nervous system. Oxidative stress is also thought to promote tissue damage in multiple sclerosis. Current research findings suggest that omega-3 polyunsaturated fatty acids (PUFAs) such as eicosapenta-enoic acid (EPA) and docosahexaenoic acid (DHA) contained in fish oil may have anti-inflammatory, antioxidant, and neuroprotective effects. The aim of the present work was to evaluate the efficacy of fish oil supplementation on serum proinflammatory cytokine levels, oxidative stress markers, and disease progression in MS. 50 patients with relapsing-remitting MS were enrolled. The experimental group received orally 4 g/day of fish oil for 12 months. The primary outcome was serum TNF α levels; secondary outcomes were IL-1 β 1b, IL-6, nitric oxide catabolites, lipoperoxides, progression on the expanded disability status scale (EDSS), and annualized relapses rate (ARR).
Fish oil treatment decreased the serum levels of TNF α , IL-1 β , IL-6, and nitric oxide metabolites compared with placebo group (P ≤ 0.001). There was no significant difference in serum lipoperoxide levels during the study. No differences in EDSS and ARR were found.
Fish oil supplementation is highly effective in reducing the levels of cytokines and nitric oxide catabolites in patients with relapsing-remitting MS.